The pull of pushing
In pre-colonial Hong Kong, midwifery came in the form of wan po, 'wise women' with no formal training. According to the Hong Kong Midwives Association, the first maternity hospital was established in 1904, by a Dr Sibree, who also implemented the first training programme in midwifery, based on a British curriculum. The number of maternity homes/clinics peaked between 1946 and the 1960s. From the 70s, the practice of giving birth at maternity homes gradually declined as expectant mothers moved into hospitals. The last maternity ward closed its doors in 1988. Public interest in independent midwifery began to grow again in the 90s, along with a movement against elective Caesarean sections.
Midwives functioning within the hospital system have defined and somewhat limited roles. Their role in private hospitals resembles that of obstetric nurses; they do not deliver the babies or do antenatal check-ups. In public hospitals, in-house midwives are responsible for antenatal check-ups; they care for the women in labour and deliver the babies of vaginal births.
Hulda Thorey, director of Annerley - a local maternity and early-childhood centre - finds that more and more expecting mothers are considering midwife-assisted natural births.
'For low-risk pregnancies, women who go through natural childbirth simply recover easier,' Thorey says. 'And it carries much less risk for [following] pregnancies and births.
'Natural-birth babies tend to have less respiratory or feeding issues. With C-sections, there is usually a little more separation between the mother and baby and the mother also has a harder time picking up the baby and manoeuvring things because of the wound.'
The rate of births by Caesarean section in Hong Kong is among the highest in the world. In private hospitals, the rate is about 50 per cent, most of them elective, says Dr Ares Leung of Union Hospital. Thorey places the rate in public hospitals at 30 per cent (with one-third elective), the same figure as for the United States, while in British hospitals, it is 24 per cent.
'A good portion of Caesareans in Hong Kong are elective, partly because people here seem to want to pick their dates, partly because they are scared,' says Thorey. 'People here seem to think that natural birth is very difficult. Also, there seem to be those - particularly among private doctors - who feel genuinely that the Caesarean is the safer way; whereas research does not at all support that.
'I combine the roles of a 'doula' [birthing assistant] and midwife,' says Thorey. 'The work I do is extra to the hospital systems in Hong Kong. Hopefully, with the growing demand for alternative birthing services, we can reinstate the birthing clinic.'